Workers Compensation Specialist

TSAOG Orthopedic & Spine; San Antonio (TX); On-site; USD 42,000 - 62,000; Full time

Job summary

TSAOG Orthopedic & Spine in San Antonio, TX seeks a Professional Reimbursement Specialist for Workers' Compensation to manage inquiries, coordinate with adjusters and physicians, and ensure accurate documentation for timely scheduling and authorization.

The role emphasizes compliance with healthcare regulations, data entry accuracy, and strong communication across departments to support patient care and reimbursement processes.

Qualifications

• Must have a High School Diploma or equivalent.
• Knowledge of self-insured and network Workers Compensation programs.
• Proficient computer skills and data entry.
• Excellent communication and thorough documentation.
• Ability to multi-task and prioritize work.

Responsibilities

• Manage workers compensation incoming calls, faxes, emails and referrals.
• Communicate effectively with adjusters, nurse case managers, referral sources, and physicians by obtaining or providing requested workers comp information on new or existing patients.
• Assist other departments and physician teams by providing or verifying workers comp information when needed.
• Respond to and document patient cases to ensure proper processing and scheduling.
• Submit treatment orders to utilization review companies for approval and follow up to ensure complete authorization process.
• Schedule patient appointments and workers comp appointed exams.
• Maintain knowledge and education to be effective and productive on prior authorization requirements.
• Work with individual department co-workers on special projects as requested by supervisor.
• Follow the requests and directions of department Lead, Manager, Director, and physicians.
• May be required to assist other areas in referrals/authorizations department when staffing is needed.
• Participate in monthly and quarterly meetings within respective department and team to discuss policies, protocols, and best-practices.
• Adhere to applicable healthcare laws, regulations, and orthopaedic practice policies and procedures, including requirements related to patient privacy, documentation, billing, and ethical conduct.
• Protects patient confidentiality, completes required compliance training, and promptly reports suspected compliance or ethical concerns.
• Comply with healthcare regulations and orthopaedic practice policies and procedures; ensures accurate documentation and ethical conduct; protects patient confidentiality; completes required compliance training; and reports compliance concerns in a timely manner.
• Comply with healthcare regulations and practice policies and procedures; protects patient confidentiality; and reports compliance or ethical concerns in a timely manner.

Skills

Workers Comp knowledge

Customer service

Data entry

Microsoft Office

Education

High School Diploma

Job description

Description

Job Title: Professional Reimbursement Specialist - Workers Compensation Key Responsibilities:

• Manage workers compensation incoming calls, faxes, emails and referrals
• Communicate effectively with adjusters, nurse case managers, referral sources, and physicians by obtaining or providing requested workers comp information on new or existing patients
• Assists other departments and physician teams by providing or verifying workers comp information when needed
• Responding to and documenting patient cases to ensure proper processing and scheduling
• Submit treatment orders to utilization review companies for approval and follow up to ensure complete authorization process
• Schedule patient appointments and workers comp appointed exams
• Maintain knowledge and education to be effective and productive on prior authorization requirements
• Work with individual department co-workers on special projects as requested by supervisor
• Follow the requests and directions of department Lead, Manager, Director, and physicians
• May be required to assist other areas in referrals/authorizations department when staffing is needed
• Participate in monthly and quarterly meetings within respective department and team to discuss policies, protocols, and best-practices
• Adhere to applicable healthcare laws, regulations, and orthopaedic practice policies and procedures, including requirements related to patient privacy, documentation, billing, and ethical conduct. Protects patient confidentiality, completes required compliance training, and promptly reports suspected compliance or ethical concerns.
• Comply with healthcare regulations and orthopaedic practice policies and procedures; ensures accurate documentation and ethical conduct; protects patient confidentiality; completes required compliance training; and reports compliance concerns in a timely manner.
• Comply with healthcare regulations and practice policies and procedures; protects patient confidentiality; and reports compliance or ethical concerns in a timely manner.

We offer a competitive salary and benefits package, along with opportunities for professional growth and development.

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Requirements

Skills and Qualifications:

• Must have a High School Diploma or equivalent.
• Required knowledge of self-insured and network Workers Compensation programs, rules and regulations.
• Proficient computer skills. Exceptional customer service skills. Proficient and accurate data entry skills. Proficient with Microsoft programs (Excel, Word, etc.)
• Ability to communicate effectively. Excellent research, follow-through and documentation are required.
• Prolonged sitting. Repetitive motion (data entry), and phone contact.
• Ability to multi-task, prioritize work and make sound judgements.
• Other duties as assigned as necessary and may vary at times, as needed, by your immediate supervisor or as directed by the company.
• Requires predictable and consistent attendance